MEDICAL-OFFICE ETIQUETTE Good-patient examination

By DEBRA MELANI SCRIPPS HOWARD Cell phones are creating a buzz in medical offices, and it has nothing to do with who has the slickest model or the cheapest rates. Many of the nearly 130 million American cell-phone users are answering their mobiles so often in exam rooms that doctors are resorting to tacking up "no cell phone" signs outside their doors. This latest patient no-no isn't the only one throwing a wrench into an already overstressed health-care system. Fighting family members, rambunctious kids and ill-prepared patients also are causing doctors to shake their heads at the end of the day. These blunders might be irritating in any setting, but in a doctor's office the stakes can be higher: hindering communication, causing delays and possibly leading to poorer care. Here's a look at the top mistakes that irritate doctors and can detract from quality of care: High-tech menace "I cannot tell you how many times I've had clinic visits interrupted by cell phones," said Dr. John Song, an oncologist with the University of Colorado Hospital in Denver. "I'll sort of take a deep breath and wait." The problem grew so large that Dr. Jandel Allen-Davis, an obstetrician with Kaiser Permanente of Colorado in Denver, posted a "no cell phone" sign. In her specialty, when a patient picks up a cell phone midexam, it can be almost humorous. "I had a woman in the middle of her pelvic exam, feet up in the stirrups, talking on the phone," Allen-Davis said. But generally, doctors agree, cell phones hinder patient care. Inadequate support Another patient faux pas that doctors often see is a failure to bring support -- or the right type of support -- to a potentially serious exam, Song said. As a cancer specialist, Song says his patients' visits are often loaded with important but hard-to-take information. He suggests patients bring along two people who have been assigned tasks beforehand: one to take notes, the other to provide a shoulder to lean on. Patients should ensure that these two people are compatible, Song said, judging by a memorable appointment he related: A patient had just learned she had cancer and brought her two adult daughters to the next exam. Every time Song said their mother needed something, whether an appointment or a prescription, the daughters argued about who would handle it, he said. "The moral of the story is to be aware of family dynamics," Song said. And keep a reasonable limit on the number of supporters, he added. "I had one patient come with 12 family members," he said. "You can't even fit that many people into a clinic office." Toddling tots Another thing that can sabotage a doctor's exam is children, especially uncontrolled tots, doctors say. "It's disruptive," Song said. "It really takes away from the interaction." On the list To ensure an efficient and effective doctor's exam, patients should bring a well-thought-out list of symptoms and questions, doctors say. It's inevitable that patients forget things. "The best one is: 'Oh, by the way,'" Allen-Davis said. "You have your hand on the doorknob, and you have to come back in and sit down." The patient's afterthought can be something critical to a correct diagnosis, completely changing conclusions the doctor had made, she said. Also, patients should bring a list of all medications and nonprescription supplements they're taking, along with the dosages. Song, who sees many patients referred by other doctors, said patients also need to take responsibility for their own medical records and bring them to the appointment. "Don't rely on the office to send them to the other doctor," he said. That goes for all records, including diagnostic tests.